good morning, this is news 4 your sunday. >> good sunday morning. i'm pat lawson muse. there's no final bill but we now know of the changes we could see under the senate republican plan to repeal and replace the affordable care act. how could the changes effect you? we'll take a look at that with a nonpartisan not for profit organization. joining us this morning is aaron turner pfeffer. he is director of government relations and your organization monitors the quality and best practices of health care organizations. things like health care plans and farm sis a

organizations. just to establish what you do. you said that it's a mistake to assume if you're not enrolled on a health exchange or on medicaid that these changes being talked about wouldn't effect you. >> correct. that's some of the questions i get from family and friends but most folks aren't aware of is the affordable care act had a number of consumer protections that apply broadly to all health plans. there's a number of different things that the plan can do to help everyone that had insurance be it through medicaid or exchanges or your employer. >> so everyone should be paying attention. >> everyone should be paying attention. >> some of the parts of the affordable care act have been medicaid expansion, the individual mandate and subsidies so under the plan that the senate is considering, the mandate goes away. >> correct. >> all right. so the -- we wouldn't be

people wouldn't be forced to buy insurance but they would be encouraged to buy insurance. explain that? >> so in the house plan there's an incentive to buy insurance or you might face a penalty if you come in. under the senate plan there's no incentive. the goal i believe is to lower premiums enough that younger folks would be encouraged to buy insurance. that's one of the things the affordable care act struggled with, especially recently is skyrocketing premiums for folks. >> part of the senate would be to attack lower premiums. >> especially the insurance changes are still intact. if there's a tax credit or subsidy for folks that encourages them to buy insurance. if you can bring down the cost of the premium the tax credit is more valuable. less money out of pocket for you in theory. the question would be whether young people would buy in. >> that is. >> whether they would be encouraged. >> that is theue

you talk to it could be either way and that's some of the political debate that's happening but there's certainly no answer yet as to which way it might go. >> then if they did decide to accept the enticement what about the quality of the insurance or the benefits. >> organizations like ours are going to ensure that the quality is the same. the question at hand might be what does the benefit package look like? and there's provisions in the house and senate versions that would allow states to decide and change what has been written in the law for minimum benefits under the affordable care act. >> let's talk about those that are over 65 that may be on medica medicare. some may be on medicare and medica medicaid. >> that's one of the biggest changes to the health care delivery system in the house and

a roll back of the expansion and funding in the funding for medicaid in general. so you could still be impacted by some of the potential cuts that the senate is planning to make in the long-term. >> we were hearing that the cuts in the long-term would be deeper. >> yes. it's a very economical way that happens based off of inflation and how you plan to spend money but the reality potentially could be less real dollars spent in medicaid that. means that states are going to have to make really tough decisions about what services they cover and what populations get the most benefit from medicaid. >> so in a state like virginia for example that did not buy into the medicaid expansion would there be a lesser impact on those that are low income, seen yors, disabled, then places like maryland and the district that did buy into the medicaid expansion. >> yeah. i think considering what the greatest impact would be on the

greatest impact as they expanded their medicaid enrollment and population. maryland had a growth of almost 50% in terms of medicaid population from 2010 until now. so comparatively virginia will have less of an impact but the impact is going to be real once you get beyond 2021 when the senate plans to cap some of the spending on the nonexpansion medicaid population. >> all right. we're talking about proposed changes in health care. talking specifically about the senate bill now being considered. we'll be right back in a minute.

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the bill that would change health care. aaron turner pfeffer what

change. let's talk about that. pre-existing conditions is one of the most scary aspects of all of this because most people that i know have pre-existing conditions. but that's one of the things that really wouldn't change that mu much. correct. pre-existing conditions won't be a mechanism to deny folks coverage. >> seem to be able to under either the senate or the house plan which would pass, be able to exclude some pre-existing conditions when we have the latitude to go in and tweak this or to get a waiver. >> yeah, under the house bill yes. under the senate bill no but i think you'll have the option to tweak some of the minimum benefits we talked about and that's an option in the house and senate version so you're likely to see states go in and say we may not want to cover all as a

insurance plan has to provide to offer coverage in the state. those are likely the types of things that are going to be trade offs that folks are going to make to lower premiums but gietsd to recognize that the idea of of allowing pre-existing conditions to be a business tool insurers can use is probably something most folks don't want to see. >> mental health care is essential. then you maternity care, prescription drug coverage, how about those, what are we looking at there? >> that would be a trade off that each state would have to make. each community, each state, their markets and their populations are different. each state is going to have to evaluate under the house and senate version what works best for their state and one of the very wonky details in an insurance policy is employers also have to benchmark those

your state requires maternity care to be covered then your employer if they offer maternity coverage has to operate in the same way in terms of dollar value and out of pocket spending for you. those are things that could impact everyone and those are options that each state would have to undertake in the senate or house version. >> there is a lot of concern right now about the opioid drug crisis sweeping the nation and and health insurance is not the only issue there in getting that he demic under control but it would be impacted if some of these cuts take place. >> there's a recognition on the part of republicans in the house and senate that some of the changes in insurance may impact access to some of the services that are required to treat opioid addiction. the senate left a significant amount of money in there to invest in community resources for these folks but regardless o

the affordable care act. this is a broader issue and public health issue and resources are going to continue to be invested and there's real push among the industry and public officials that commit a significant amount of resources to give these folks the help they need. >> getting back to what hasn't changed or what wouldn't change if w the senate bill if you're under 26 you still stay on your parents plan. >> you're still on your parents plan. >> that didn't change with the house plan either did snit. >> correct. that provision is still in there. that's something that again is recognized as being that. >> what else wouldn't change? >> that's a great question. so much of the frame work is still there. you hear a lot of repeal and replace. this is kind of repeal and change around the edges but a lot of the details are going to change but much of the structure that exists is still going to be in place. >> we know

would cut most of the taxes. who is now paying those taxes? >> i'm not an economist but i don't think anyone would pay those taxes. the repeal -- >> aca tax healthy americans that had investments device manufacturers, pharmaceutical companies, insurers, all of those folks would have their taxes repealed under the senate and the house version. >> how would that help you or me? or would it impact you or me or anyone else? >> i think it impacts us all from this respect and what is most important is this bill is a piece of a 20% of the american economy and any changes fundamental as to how insurance is delivered in this country is going time pact us all and one of my big messages is you have to pay attention to what's happening because it's going to impact you somewhere down the road even if you're not on medicaid. >> let's take another break and we'll continue our talou

welcome back. we're talking about the senate proposed health care bill. let's talk about subsidies. who would be eligible? >> sure. so the frame work in the house and senate for subsidies is the same. the house tags their subsidies in terms of how much money you're going to get to subsidize your insurance. tag that mostly to age. they keep much of the aca provisions in place. they tag it mostly as income so it still ranges from actually is it nat version is something unique. it allows you to go below the poverty line all the way up to 400% in the first couple of years and down to 350% of the line. >> let's talk about what that means in terms of dollars and scents.

right around $12,000. >> for a family of 24. >> 24,000 for a family of 4 is right at 100% of the federal poverty line. >> it's not a lot of money and that's a national rate so you can imagine what those dollars mean in real value for the area. things are so much more expensive than if you go even an hour south in virginia. >> so how would the subsidies change again? >> so subsidies would change in terms of the dollar amount. so fewer in terms of the total amount that would be provided to individuals buying on the exchanges and then who is eligible is one of the wiggest changes. in the senate version those folks that are eligible are below the poverty line down to 350%. the house side tags that money. you get more money. you get a little bit less money in real dollars if you're older. more money in real dollars if you're younger. the idea is

to enroll so that they try to give them a little bit more money on the front end but hopefully lower the overall cost on the back end. >> let's revisit for a moment the medicaid expansion thing because the senate bill more slowly phases out expansion. so we're talking about in 2020 which is 2.5 years from now. what happens after? after the expansion goes away. >> so the expansion goes away and my read of the senate version is these folks will be eligible by coverage on the exchange. they have offered subsidies. they lowered those that were eligible from subsidies and that's the belief. once you roll back the medicaid expansion you can give these folks access to coverage on the exchanges. >> what's the other argument? tnchts other argument might be that these folks can't afford the insurance that they have got. i

premium you can afford there might be out of pocket costs associated that prohibit you from using your insurance coverage. >> so if you are on medicaid and you're looking at this whole picture right now, you might be a little nervous? >> yeah. i think change is always difficult and i think all of us should be acutely aware of any changes that may impact us. >> what does your organization feel needed to be fixed to address the real concern that the insurance companies have? the concerns about, you know, spiraling health care costs? >> sure. >> as well as, you know, premiums and the quality of health care. >> so i can speak for myself. the organization is nonpartisan. no matter the system we're operating in our focus is on quality so we're an acute observer of the delivery systems nationally and on a basis that

but from my perspective the affordable care act and the house and senate version are focused on insurance coverage and some of the issues with affordability are broader than that. a great example is the cost of oil goes up and the cost of gas goes up. if the cost to deliver coverage goes up so does the cost of insurance. so we have to assume these folks still need to have their issues addressed by the medical community and these folks ultimately wait until they reach a point that they have to go to an emergency room and they often can't afford the expensive emergency room costs so the hospital has to offset the costs somewhere else. they end up offsetting the cost for folks that have employer insurance and those are the issues that drive up the cost of coverage for all of us and we he can focus as a country on getting at the root of some of those issues then some of the conversations aroundn

and insurance design become easier. >> does either bill address the rising cost of care? >> the affordable care act did a couple of different things to try to pilot experiment with some of the issues associated with rising cost of care. neither bill removes or slows down the efforts that are underway. >> got to take a break. we'll be right back. stay with us.

either impedes efforts to address this problem of the cost of care. can you expand on that? >> sure the affordable care act leveraged something already happening in the public and private sector and that was focussing on experiments that would lower the cost of care and they do tha

instead of paying for every surgery we're going to pay for outcome of that surgery. open heart surgery we expect a positive guideline and we want to make sure you don't come back through the emergency room with a problem and if you do come back then the hospital will pay for that was it will be their own mistake or failure to follow up on their part. those are some of the experiments that are happening. neither one of these bills would impede those. there seems to be incentives among the political side and stake holders that this is the right way to go so there hasn't been any slow down to try to achieve some positive result. >> so as we observe the debate played out and the debate over the bills, what do you advise people who are already covered by the employers, do we need to do anything? and we do need to be concerned about what's coming down the pike? >>

my nonpartisan hat requires me to say that but being engaged is more important now than ever. there's only a couple of things that everyone agrees on. taxes are too high. cost of education is too high and health care is too high. any changes to those require our attention and with the changes being considered may impact us all. staying engaged with what's happening in the news, staying engaged with what's happening in your own work place is very important. >> what happens next? the senate bill is on the table. >> the senate is going to have a vote at the end of next week or the end of this week and we'll know more on how things shake out once they have an idea of how many votes they think they can get. >> and what if the senate rejects this bill? >> we're back to a starting line. the house rejected the initial version of their bill and everyone thought it was great and it came back and never

there is a set back in the senate it would seriously hamper the potential for something get dung this year. >> and what if something is done? let's say the senate does pass the bill this week or meets the july 4th deadline which is the deadline that's been thrown out there. >> the senate is successful and they pass the bill out they'll get a conference assuming they try to mesh these two different versions together and whatever comes out of that conference committee both will have to vote on and assuming both shame bermudas a agree and pass it it will go to president trump for a vote. >> you have already explained i think pretty clearly that there's issues that need to be addressed and changes that are coming so whether it's this bill or the house bill or a combination or they go back to the beginning and start all over we're in for a major change of th

aren't we? >> yeah and i think the affordable care act was just one step along what's probably going to be a generational change in health care. these two versions of the bill are an iteration of the next change. i think even supporters of the affordable care act would agree that some things need to change to make sure that it continues. reforwardless if it's this bill or another bill we're all in for changes and it requires our attention. >> all right. fasten our seat belts? >> absolutely. all right. thank you. >> thank you for being with us and helping to explain all of that to us this morning. for more on the senate's proposed bill log on to nbc washington and click on community. that's news 4 for your sunday. thank you for being with us. news 4 today is next.

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it is a day that we have been warning you about for months. major changes at metro start today and the impact those changes will have on your wallet and wait time. a developing story out of virginia this morning, toddlers found in the family pool and the tragic out come. we have a fantastic finish when it comes to the weather, and the sunday forecast is looking great and we are looking at a major cooldown during the workweek. first, good morning on this sunday. welcome in, we have a beautiful sunrise. >> i thought you were